Socioeconomic and psychosocial correlates of oral health

Psychosocial factors, dentist-patient relationships, and oral health-related quality of life: a structural equation modelling

BACKGROUND

Psychosocial factors and dentist-patient relationships (DPR) have been suggested to be associated with oral health outcomes. This study aimed to test a conceptual model which hypothesised relationships among psychosocial factors, DPR variables, and oral health-related quality of life (OHRQoL) in the 'distal-to-proximal' framework.

METHODS

A total of 12,245 adults aged 18 years or over living in South Australia were randomly sampled for the study. Data were collected from self-complete questionnaires in 2015-2016. The outcome variable of Oral Health Impact Profile was used to measure OHRQoL. Psychosocial domain consisted of psychological well-being, social support, and health self-efficacy. DPR domain included trust in dentists, satisfaction with dental care, and dental fear. The hypothesised model was tested using the two-step approach in structural equation modelling.

RESULTS

Data were analysed from 3767 respondents after the screening/preparing process (adjusted valid response rate 37.4%). In the first step of the analysis, confirmatory factor analyses produced acceptable measurement models for each of the six latent variables (GFI = 0.95, CFI = 0.98, RMSEA = 0.04). The final structural model indicated that better well-being, higher self-efficacy, and more satisfaction were associated with lower oral health impact (β = - 0.12, - 0.07, - 0.14, respectively) whereas fear was positively associated (β = 0.19). Among intermediates, support was positively associated with satisfaction within a small effect size (β = 0.06) as compared to self-efficacy with trust (β = 0.22). The invariance of the final model was also confirmed on participants' SES and dental service characteristics except the variable of 'last dental visit'.

CONCLUSIONS

Psychosocial factors and DPR variables were associated with oral health impact in both direct and indirect paths. The framework of 'distal-to-proximal' actions is empirically supported from psychosocial factors via DPR variables to OHRQoL.

Efficacy of Sub-Gingivally Delivered Propolis Nanoparticle in Non-Surgical Management of Periodontal Pocket: A Randomized Clinical Trial

Naturally sourced products like propolis are commonly employed for the non-surgical treatment of periodontal pockets. The use of nanoparticle formulations of these natural remedies has the potential to improve treatment outcomes. The aim of the present study was to evaluate the efficacy of sub-gingivally delivered propolis nanoparticles in the non-surgical management of periodontal pockets. Forty patients diagnosed with periodontitis presenting at least one periodontal pocket with a probing pocket depth between 4 and 6 mm were selected. Patients were randomly assigned into the control group (n = 20), which received scaling and root planing (SRP) and saline (SRP + Saline), and the test group (n = 20), which received SRP and sub-gingivally delivered propolis nanoparticles (PRO) into the periodontal pocket (SRP + PRO). The clinical parameters recorded were plaque index (PI), gingival index (GI), relative attachment loss (RAL), probing pocket depth (PPD), and bleeding on probing (BOP). They were assessed at baseline, one month, and three months post therapy. The results indicated that there was a significant improvement in clinical parameters (p < 0.05) in the test sites compared with the control sites at the end of the study. The gingival index at one month and three months was found to be significantly better in the SRP + PRO group than the SRP + Saline group, with a p value of <0.001. The BOP, PPD, and RAL showed significant improvement with the SRP + PRO group at the end of the 3-month follow-up with p values of 0.0001, 0.001, and 0.05, respectively. The subgingival delivery of propolis nanoparticles showed promising results as an adjunct to SRP in patients with periodontitis presenting periodontal pockets.

Children oral health and parents education status: a cross sectional study

INTRODUCTION

Oral diseases are common and affect millions of people worldwide. They can range from mild and easily treatable conditions to more severe and serious diseases. Proper oral hygiene and regular dental monitoring are essential for maintaining good oral health. When it comes to children's health and well-being, parents' education level plays a critical role. Research has shown that parents' higher educational attainment is associated with better health outcomes for their children. Our aim is to evaluate whether parents' education level and employment influence children oral health and its impact on the family.

METHODS

We enrolled consecutively healthy subjects aged between 0-16 and their parents at the Dental Clinic of the University of Campania "L. Vanvitelli". The Italian version of the ECOHIS (I-ECOHIS) was administered to parents of the enrolled subjects referred to the Dental Clinic of the University of Campania "L. Vanvitelli". Linear regression models, adjusted for age and sex, were used to explore the association between parents' employment or education level and the ECOHIS scores. Statistical significance was accepted when p value < 0.05.

RESULTS

We found a significative association of a higher I-ECOHIS total score (coeff. 4.04244; CI 95%: 1.530855-6.554026; p = 0,002) and higher I-ECOHIS children section score (coeff. 3.2794; CI 95%: 1.29002-5.268; P = 0,002) and the father unemployed status. We also found that a higher education level of the father was associated with a lower ECOHIS total score (coeff. -1.388; IC 95%: -2.562115--0.214 p = 0.021) and a higher education level of the mother was associated with a lower ECOHIS in children section (coeff. -0.972; IC95%: -1.909356-0.034; p = 0.042).

CONCLUSIONS

Father unemployed status and a lower educational level for both parents may negatively affect oral health status.

Burnout: A predictor of oral health impact profile among Nigerian early career doctors

There have been reported association of oral health disorders with burnout, stress, and mental health. Arguably, with these reported associations, and the current prevalence of burnout amongst Nigerian doctors, exploring the role of burnout on oral health amongst Nigerian doctors is timely. This study aims to determine the relationship between burnout and oral health-related quality of life amongst Early Career Doctors (ECDs) in Nigeria, while also identifying the role other possible predictors plays in this relationship. This was a cross-sectional study conducted amongst Nigerian ECDs as part of Challenges of Residency Training in Nigeria (CHARTING) II project. A total of 632 ECDs were recruited across thirty-one tertiary hospitals in the 6 geopolitical zones of the country using a multistage cluster sampling technique. A self-administered paper-based semi-structured questionnaire was given to each participant that consented. The tools used to assess burnout and Oral health-related quality of life (OHRQoL) were Copenhagen Burnout Inventory (CBI) and Oral Health Impact Profile (OHIP-14) respectively. Independent samples T-test, ANOVA and Multiple linear regression were used to draw inferences from the data collected. Overall mean OHIP-14 score of all participants was 11.12 (±9.23). The scores for the 3 dimensions of burnout were below 50% with CBI-Personal Burnout having the highest score of 49.96 (±19.15). Significant positive correlations (p < 0.001) were found between OHIP-14 and all the dimensions of burnout, as the burnout scores were increasing, there was a corresponding increase in the OHIP scores thus poorer OHRQoL. The regression model shows that the predictors of OHIP were CBI-PB (p = 0.003), use of fluoride paste (p = 0.039), use of tobacco (p = 0.005) and being a denture user (p = 0.047). This study shows a positive correlation between burnout and OHIP of ECDs. We found that as burnout was increasing, OHIP increased thus implying poorer oral health related quality of life amongst ECDs. The use of fluoride toothpaste, tobacco and denture are other factors we found that could affect the OHIP of ECDs.

Social and economic capital as effect modifiers of the association between psychosocial stress and oral health

OBJECTIVES

To assess the extent of the association of psychosocial stress with oral health in an Ontario population stratified by age groups, and whether any association is modified by indicators of social and economic capital.

METHODS

We retrieved data of 21,320 Ontario adults, aged 30-74 years old, from the Canadian Community Health Survey (CCHS: 2017-2018), which is a Canada-wide, cross-sectional survey. Using binomial logistic regression models that adjusted for age, sex, education, and country of birth, we examined the association of psychosocial stress (indicated by perceived life stress) with inadequate oral health (indicated as having at least one of the following: bleeding gums, fair/poor self-perceived oral health, persistent oral pain). We assessed the effect measure modification of indicators of social (sense of belonging to the local community, living/family arrangements) and economic capital (household income, dental insurance, dwelling ownership) on the perceived life stress-oral health relationship, stratified by age (30-44, 45-59, 60-74 yrs). We then calculated the Relative Excess Risk due to Interaction (RERI) which indicates the risk that is above what would be expected if the combination of low capital (social or economic) and high psychosocial stress was entirely additive.

RESULTS

Respondents with higher perceived life stress were at a significantly higher risk of having inadequate oral health (PR = 1.39; 95% CI: 1.34, 1.44). Adults with low social and economic capital were also at an increased risk of inadequate oral health. Effect measure modification showed an additive effect of indicators of social capital on the perceived life stress-oral health relationship. This effect was evident across all three age groups (30-44, 45-59, 60-74 yrs), with the highest attributable proportion of social and economic capital indicators in the psychosocial stress-oral health relationship in older adults (60-74 yrs).

CONCLUSION

Our findings suggest an exacerbating effect for low social and economic capital in the relationship of perceived life stress with inadequate oral health among older adults.

Association between COVID-19 stress, coping mechanisms and stress-related oral conditions among Egyptian adults: a cross-sectional study

The present study investigated the association between COVID-19 stresses and oral conditions including gingivitis, oral hygiene, oral ulcers, and dry mouth. This was a cross-sectional study that collected data from adults in community settings in Alexandria, Egypt, between October 2021, and February 2022. Gingival condition and oral hygiene were assessed using the gingival and plaque indices. Participants were asked if they experienced oral ulcers during the past week and dry mouth during the past year. COVID-19 fears and coping were assessed using the COVID Stress Scale (CSS), and the Brief Resilience Coping Scale (BRCS), respectively. Oral health behaviors were assessed using the World Health Organization questionnaire. Regression analyses were used to assess the association between the dependent variables (clinically assessed gingival and plaque indices, reported presence of oral ulcers, and dry mouth) and explanatory variables (CSS and BRCS) after adjusting for confounders (COVID-19 status, oral health behaviors, smoking, age in years, sex, and highest educational level). The response rate was 88.8% (373/420). The mean (SD) age = 39.26 (11.45) with 74.3% females and 49.3% reporting completing high school or higher education. The mean (SD) plaque and gingival indices were 1.59 (0.66) and 1.39 (0.59), respectively. Only 20.1% reported the presence of oral ulcers and 41.6% reported xerostomia. Lower plaque score was associated with higher COVID-19 contamination fears (B = - 0.03, 95% CI - 0.05, - 0.02) and higher compulsive checking and reassurance-seeking (B = - 0.02, 95% CI - 0.03, - 0.009). Lower gingival score was associated with higher COVID-19 contamination fears (B = - 0.02, 95% CI - 0.03, - 0.002). Higher odds of reporting dry mouth were associated with greater fear of COVID-19 socioeconomic consequences (AOR = 1.05, 95% CI 1.001, 1.09), and lower coping scores (AOR = 0.93, 95% CI 0.88, 0.99). The findings suggest an association between COVID-19 specific stresses and stress-related oral conditions and shed light on the possible link between mental and oral health, emphasizing the importance of integrated planning of care services.

Self-efficacy and oral health outcomes in a regional Australian Aboriginal population

BACKGROUND

Perceived self-efficacy has been associated with psychological well-being, health behaviours and health outcomes. Little is known about the influence of self-efficacy on oral health outcomes for Aboriginal adults in Australia, a population experiencing high levels of oral health conditions. This study examines associations between oral health-related self-efficacy and oral health outcomes in a regional Aboriginal Australian population and investigates whether the associations persist after adjusting for sociodemographic characteristics and other general and oral health-related psychosocial factors.

METHODS

Cross-sectional data were obtained from the baseline questionnaire of the Indigenous Oral Heath Literacy Project, South Australia. Oral health-related self-efficacy was measured using a six item scale, with total sum scores dichotomised into high/low self-efficacy. Oral health outcomes included self-rated oral health and oral health impacts, measured using the Oral Health Impact Profile (OHIP-14). Generalized linear models with a log-Poisson link function were used to estimate Prevalence Ratios (PR) of poor self-rated oral health according to levels of oral health-related self-efficacy. Multivariable linear regressions were used to estimate the association between oral health-related self-efficacy and OHIP-14 scores. Blocks of confounders were subsequently added into the models, with the final model including all factors.

RESULTS

Complete data were available for 252 participants (63%) aged 18 to 82 years (mean age of 37.6 years). Oral health-related self-efficacy was associated with poor self-rated oral health, with a 43% (PR = 1.43 (95% CI 1.09, 1.88)) greater prevalence of poor self-rated oral health among those with low self-efficacy. Oral health-related self-efficacy was associated with OHIP-14 severity scores, with a score over six points higher for those with low self-efficacy (B = 6.27 95% CI 2.71, 9.83). Although addition of perceived stress into the models attenuated the relationship, associations remained in the final models.

CONCLUSION

Lower levels of oral health-related self-efficacy were associated with a higher prevalence of poor self-rated oral health and greater impacts of oral health among Aboriginal adults in regional South Australia. These associations persisted after controlling for sociodemographic and psychosocial confounders, suggesting that increasing self-efficacy may provide an opportunity for improving oral health outcomes for Aboriginal adults.

Pathways of socioeconomic inequalities in self-perceived oral health

Although there is a large body of evidence of the influence of social determinants on oral health, information on the mechanisms by which these determinants operate is poorly documented. Therefore, we aimed to investigate the pathways through which socioeconomic inequalities may influence self-perceived oral health (SPOH) in Brazilian adults. This cross-sectional study used data from the National Health Survey (NHS) of 2019, with a representative sample of adults aged 18 to 59 years (n = 65,803). The outcome was SPOH, assessed by a global self-item. Structural equation modeling was used to test direct and indirect pathways connecting a latent variable for socioeconomic position (SEP) to SPOH via psychosocial, behavioral, and biological factors. Higher SEP was directly associated with better SPOH [standardized coefficient (SC) = 0.069; p < 0.01)] fewer depressive symptoms (SC = -0.059; p < 0.01), fewer missing teeth (SC = 0.131; p < 0.01), and more healthy behaviors (SC = 0.643; p < 0.01). Fewer depressive symptoms (SC = -0.141; p < 0.01), more healthy behaviors (SC = 0.242; p < 0.01), and fewer missing teeth (SC = 0.058; p < 0.01) were directly associated with good SPOH. Among specific indirect effects of SEP on SPOH, the behavioral pathway was the one that best explained this association (SC = 0.155). Socioeconomic inequities in SPOH are mediate by psychosocial, behavioral, and biological factors. This has implications for positioning health strategies in the social context in which people live, to facilitate healthy choices and promote good oral health.

Effect of Morbidities, Depression, Anxiety, and Stress on Oral Health-Related Quality of Life among Migrant Elderly Following Children in Weifang, China

This study explored the relationship between depression, anxiety, stress, morbidity, and oral health-related quality of life (OHRQoL) in the migrant elderly following children (MEFC) in Weifang, China. A total of 613 MEFC were selected using multistage cluster random sampling. The GOHAI scale was used to evaluate oral health-related quality of life. The DASS-21 scale was used to assess levels of depression, anxiety, and stress. Univariate analysis and binary logistic regression were used to analyze the correlation between these indicators and oral health-related quality of life, of which 43.9% were classified as having poor oral health. Logistic regression analysis showed that the MEFC who were of older age (OR = 0.965, p = 0.039), with hypertension (OR = 0.567, p = 0.004), with gastroenteropathy (OR = 0.263, p = 0.007), had received an outpatient service in the past year (OR = 0.669, p = 0.048), were depressed (OR = 0.338, p = 0.012), and anxious (OR = 0.414, p = 0.026) were less likely to report good oral health status. On the other hand, the MEFC with a high school education or above (OR = 1.872, p = 0.020) were more likely to report good oral health than those with primary school education and below. In conclusion, with regard to depression, anxiety, and stress: the results indicated that the fewer morbidities, the lower the level of depression and anxiety and the better the OHRQoL of MEFC. Targeted measures for government, communities, and family members were given to improve the OHRQoL of MEFC.

Neighbourhoods and oral health: Agent-based modelling of tooth decay

This research used proof of concept agent-based models to test various theoretical mechanisms by which neighbourhoods may influence tooth decay in adults. Theoretical pathways were constructed using existing literature and tested in two study areas in Sheffield, UK. The models found a pathway between shops and sugar consumption had the most influence on adult tooth decay scores, revealing that similar mechanisms influence this outcome in different populations. This highlighted the importance of the interactions between neighbourhood features and individual level variables in influencing outcomes in tooth decay. Further work is required to improve the accuracy and reliability of the models.

Structuring adolescent's oral health effects on labour market entry in a cohort study

AIM

To evaluate the influence of the oral conditions and oral health-related quality of life (OHRQoL) on the entry of adolescents on labour.

DESIGN

This cohort study was performed in southern Brazil, within a random sample of 12-year-old adolescents (n = 1134). Oral health (dental caries, malocclusion, and toothache), OHRQoL (Child Perceptions Questionnaire 11-14), demographic factors, and family's socioeconomic status (household income and mother's education) were collected at baseline (2012). Education level and employment outcomes, such as labour market entry and earnings from work, were collected at 6-year follow-up. Path analysis was used to estimate the overall fit measurement, standardized coefficients (SC), and its direct and indirect effects.

RESULTS

Among 1134 participants, 768 adolescents with mean of age 17.5 years old were reassessed (retention rate of 68%). There was direct effect from poor OHRQoL on labour market entry (SC 0.057; P = .02). Sex and age also had a direct effect on employment outcomes. Socioeconomic status impacts oral health conditions as well as OHRQoL scores (P < .01). Household income, malocclusion, and toothache had indirect effects on labour market entry.

CONCLUSION

Oral health indirectly affects employment outcomes, through its effects on OHRQoL. Moreover, OHRQoL directly affects labour market entry in adolescents.

Assessing Oral Health Status, Practices, and Access to Care among War-Affected Refugees Living in San Antonio, Texas

OBJECTIVES

 Refugees encounter several health disparities including oral health problems. This study evaluated the self-reported oral health status, practices, and access to care of adult refugees living in San Antonio, Texas, United States.

MATERIALS AND METHODS

 Adult refugees (n = 207) who accessed services from two centers in San Antonio, completed this survey. Multivariate logistic regression was used to examine the relationship of the refugees' demographics with oral health status, practices, and access to care.

RESULTS

 Oral pain in the previous 12 months was common among refugees having been reported by almost 58.9% of the survey participants; 43% reported pain as the reason for their last dental visit. Approximately half of the participants reported both the condition to their teeth and gums as being good: 42.5 and 54.6%, respectively. Most participants (84%) reported brushing their teeth one or two times a day, and around 78% reported they never smoked. Fifty-two percent reported needing dental care in the past 12 months, but not being able to receive it; while 45.9% reported not having dental insurance, 41.5% reported not having money to pay a dentist. Fifteen percent reported never visiting a dentist. Arabic speakers, moving to the United States more recently, and lower level of education were associated with a poor oral health status and practices (p < 0.05).

CONCLUSION

 Refugees in this study encountered limited access to dental care. Their inability to seek dental care could affect their oral and general health, weaken efforts of preventing oral health diseases, and restrict their full inclusion into the community.

Socioeconomic-related inequalities in oral hygiene behaviors: a cross-sectional analysis of the PERSIAN cohort study

Background

Socioeconomic-related inequality in oral hygiene behaviors in Iran is poorly understood. This study aims to measure and decompose socioeconomic-related inequalities in oral hygiene behaviors among middle-aged and elderly adults in Iran.

Methods

A cross-sectional analysis was performed using data from the Prospective Epidemiological Research Studies in IrAN (PERSIAN), a large national cohort study. A total of 130,016 individuals aged 35 years and above from 17 cohort centers in Iran were included in the study. The normalized concentration index (C_n) was used to measure the magnitude of inequality in oral hygiene behaviors, i.e. brushing at least twice and flossing once daily, among middle-aged and elderly Iranian adults included in the cohort centers. Decomposition analysis was performed to quantify the contribution of each determinant to the observed inequality in oral hygiene behaviors.

Results

Totally, 65.5% of middle-aged and elderly adults brushed their teeth twice a day or more, 7.6% flossed at least once a day and 3.48% had both habits. The estimated C_n of the two habits combined, i.e. tooth brushing and dental flossing, for all provinces taken part in the PERSIAN cohort study was 0.399 (95% confidence interval [CI]: 0.383 to 0.417), indicating that the prevalence of the two habits combined is more concentrated among individuals with higher socioeconomic status. Inequality in oral hygiene behaviors was pro-rich in all cohort centers. The decomposition results suggested socioeconomic status as the main factor contributing to the overall inequality, followed by the level of education, and the province of residence.

Conclusion

A low prevalence of oral hygiene behaviors among middle-aged and elderly Iranian adults was observed. There was also a pro-rich inequality in oral hygiene behaviors among middle-aged and elderly adults in all cohort centers. These results suggest an urgent need for targeted policy interventions to increase the prevalence of preventive oral hygiene behaviors among the poor and less-educated middle-aged and elderly adults in Iran.

Association between early childhood caries and poverty in low and middle income countries

Background

The aim of this study was to assess the relationship between early childhood caries (ECC) in 3–5-year-old children, seven indicators of poverty and the indicator of monetary poverty in low- and middle-income countries (LICs, MICs).

Methods

This ecologic study utilized 2007 to 2017 country-level data for LICs and MICs. Explanatory variables were seven indicators of poverty namely food, water, sanitation, health, shelter, access to information, education; and monetary poverty. The outcome variable was the percentage of 3–5-year-old children with ECC. A series of univariate general linear regression models were used to assess the relationship between the percentage of 3–5 year-old children with ECC and each of the seven indicators of poverty, and monetary poverty. This was followed by multivariable regression models to determined the combined effect of the seven indicators of poverty, as well as the combined effect of the seven indicators of poverty and monetary poverty. Adjusted R² measured models’ ability to explain the variation among LICs and MICs in the percentage of 3–5-year-old children with ECC.

Results

Significantly more people had food, sanitation, shelter, access to information, education and monetary poverty in LICs than in MICs. There was no difference in the prevalence of ECC in 3–5-year-old children between LICs and MICs. The combination of the seven indicators of poverty explained 15% of the variation in the percentage of 3–5-year-old children with ECC compared to 1% explained by monetary poverty. When the seven indicators of poverty and the indicator for monetary poverty were combined, the amount of variation explained by them was 10%. Only two of the poverty indicators had a direct relationship with the percentage of children with ECC; there was a higher percentage of ECC in countries with higher percentage of population living in slums (B = 0.35) and in those countries with higher percentage of the population living below poverty lines (B = 0.19). The other indicators had an inverse relationship.

Conclusion

The use of multiple indicators to measures of poverty explained greater amount of variation in the percentage of 3–5-year-olds with ECC in LICs and MICs than using only the indicator for monetary poverty.

Self-rated oral health status and social and health determinants among community dwelling adults in Kenya

Background

The aims of this study were to estimate the self-rated oral health status and its associated factors in a national community dwelling population in Kenya.

Methods

A cross-sectional study based on a stratified cluster random sampling was conducted in 2015. The total sample included 4,459 individuals 18–69 years (M=40.4 years, SD=13.9). Questionnaire interview, blood pressure and anthropometric measurements, and biochemistry tests were conducted, including questions on the oral health status, general health status, oral health behaviour and socio-demographic information.

Results

Overall, 13.7% of participants reported poor self-rated oral health. In adjusted logistic regression analysis, older age (Odds Ratio-OR: 1.70, Confidence Interval-CI: 1.07, 2.69), having a lower number lover number of teeth (OR: 0.19, CI: 0.06, 0.62), having dentures (OR: 1.92, CI: 1.22, 3.03), having pain in the mouth or teeth (OR: 5.62, CI: 3.58, 8.90), impaired Oral Health Related Quality of Life (OR: 3.01, CI: 2.03, 4.47) and frequent soft drink consumption (OR: 3.62, CI: 1.89, 6.97) were associated with poor self-rated oral health.

Conclusion

High unsatisfied self-rated oral health status was found and several risk factors for poor self-rated oral health were identified that can help in guiding oral health care programming in Kenya.

Self-Rated Oral Health Status And Social And Health Determinants Among 35-65 Year-Old Persons In One Region In Myanmar: A Cross-Sectional Study

BACKGROUND

Oral diseases may be a population health problem in Myanmar. Community-based surveys may help in the selection of risk groups that may require priority attention. The study aimed to estimate the prevalence and correlates of self-rated oral health (SROH) status in an adult community sample in Myanmar.

METHODS

The study design was a cross-sectional household survey in the Magway region Myanmar. In all, 633 persons aged 35 to 65 years, responded to questions on the oral health status, general health status, oral health knowledge and behaviour and socio-demographic information.

RESULTS

Overall, 13.6% of participants reported poor SROH, and 78.5% average or poor SROH. In adjusted logistic regression analysis, oral conditions (tooth loss, cavities, bleeding gums, and teeth that are sensitive to heat or cold), better oral health knowledge, dental care attendance, and skipping breakfast were associated with poor SROH.

CONCLUSION

A high proportion of poor or average SROH status was found and several associated variables were found that can facilitate in guiding oral health care programming in Myanmar.

A public health perspective on personalized periodontics

In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.

Posição socioeconômica e autoavaliação da saúde bucal no Brasil: resultados da Pesquisa Nacional de Saúde

Resumo: Analisou-se a autoavaliação da saúde bucal da população adulta brasileira segundo a posição socioeconômica (região de residência, escolaridade, renda e classe social), explorando as variáveis com maior sensibilidade para medir tal associação. Estudaram-se 59.758 indivíduos com 18 anos ou mais de idade, que participaram da Pesquisa Nacional de Saúde 2013, um inquérito domiciliar de base populacional. A autoavaliação da saúde bucal (dentes e gengivas) foi analisada como positiva, regular e negativa. Com base na regressão logística multinomial, estimaram-se odds ratio (OR) brutos e ajustados e os respectivos intervalos de 95% de confiança (IC95%). Foram calculados os percentuais de concordância e o valor de kappa para comparar os valores obtidos pelos modelos de regressão e os valores esperados. A prevalência da autoavaliação da saúde bucal positiva foi 67,4%, 26,7% para regular e 5,9% para negativa. Após ajuste, a chance de autoavaliar a saúde bucal como negativa foi significativamente mais elevada entre os indivíduos com renda domiciliar per capita de até um salário mínimo (OR = 4,71; IC95%: 2,84-7,83), sem nível de escolaridade completo (OR = 3,28; IC95%: 2,34-4,61), da classe social destituídos de ativos (OR = 3,03; IC95%: 2,12-4,32) e residentes na Região Nordeste (OR = 1,50; IC95%: 1,19-1,89). Diversos indicadores de posição socioeconômica influenciam a percepção sobre a saúde bucal, mas a renda domiciliar per capita, a escolaridade e a classe social foram as responsáveis pelo maior gradiente na autoavaliação da saúde bucal de adultos no Brasil em 2013.

Does poverty cause dental caries?

Dental caries generates significant health, financial and social costs to individuals and communities, but risk factors are not spread randomly and evenly throughout populations. People from lower socio-economic status (SES) and disadvantaged groups suffer a disproportionately greater disease burden. Clinicians and public health experts view this problem through a different lens. Dentists at the clinical coalface consider individual risk factors and behaviours, for example sugar consumption, cariogenic bacteria and poor oral hygiene, as major causes of dental caries. However, considerable evidence suggests that low SES, via traditional individual risk factors as mediators and through additional independent pathways, is another significant cause. Progressive clinical practice uses education, prevention and treatment to reduce the impact of individual risk factors. Policy-makers and health administrators use population-based approaches to improve the health of societies. The authors use literature review to argue for both a greater awareness of the upstream socio-economic causes of dental caries, and action from key community sectors to redress the societal inequalities contributing to dental health inequalities.

Patients' Socio-Economic Status, Tobacco and Medical History Associated with Implant Failure

Objective

To examine the potential association between patients’ characteristics that experienced implant failure and those who had successful implant treatment.

Materials and methods

This retrospective case-control study is based on 186 dental records of implant failure and 186 age and gender matched successful treatments for a total of 372 patients. Age at the time of the procedure, gender, medical history, tobacco use, dental insurance status, ZIP code and type of treatment provided (implant failure/successful implant treatment) were recorded.

Results

The population consisted of 47.6% females, 48.9% individuals with dental insurance and 9.7% self-reported tobacco users. A statistically significant association (p≤0.05) was found between implant failure and successful implant treatment in regards to tobacco use, socio-economic status and medical history. Insurance status and implant location (region, arch) did not affect significantly (p>0.05) the outcome of implant therapy.

Conclusions

Within the limitation of this retrospective case-control study, individuals with high socio-economic status, no history of tobacco use and history of heart attack were more likely to have a successful implant treatment than those with a low socio-economic status, tobacco users and without history of heart attack.

Self-reported oral and general health in relation to socioeconomic position

BACKGROUND

During the past two decades, several scientific publications from different countries have shown how oral health in the population varies with social determinants. The aim of the present study was to explore the relationship between self-reported oral and general health in relation to different measures of socioeconomic position.

METHODS

Data were collected from a randomly selected sample of the adult population in Sweden (n = 3500, mean age 53.4 years, 53.1% women). The response rate was 49.7%. Subjects were interviewed by telephone, using a questionnaire including items on self-reported oral and general health, socioeconomic position and lifestyle.

RESULTS

A significant gradient was found for both oral and general health: the lower the socioeconomic position, the poorer the health. Socioeconomic position and, above all, economic measures were strongly associated with general health (OR 3.95) and with oral health (OR 1.76) if having an income below SEK 200,000 per year. Similar results were found in multivariate analyses controlling for age, gender and lifestyle variables.

CONCLUSIONS

For adults, there are clear socioeconomic gradients in self-reported oral and general health, irrespective of different socioeconomic measures. Action is needed to ensure greater equity of oral and general health.

[Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation]

BACKGROUND AND OBJECTIVES

Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health.

METHODS

Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale.

RESULTS

The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points.

CONCLUSIONS

The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.

Association between socioeconomic status and oral health behaviors: The 2008-2010 Korea national health and nutrition examination survey

Socioeconomic status (SES) has been reported to be associated with oral health behavior. Therefore, the present study was conducted to assess the relationship between SES and oral health behaviors in a large sample of the Korean population. Data from the Korea National Health and Nutrition Examination Survey, which was conducted between 2008 and 2010 by the Division of Chronic Disease Surveillance under the Korea Centers for Disease Control and Prevention and the Korean Ministry of Health and Welfare, were used in the present study. Daily tooth brushing frequency and the use of secondary oral products according to demographic variables and anthropometric characteristics of the participants were assessed. Multivariate logistic regression analyses were used to analyze the associations between daily tooth brushing frequency and the use of secondary oral products, and SES, urban/rural residence, body mass index (BMI), alcohol intake and smoking. An association between SES and tooth brushing frequency and the use of secondary oral products was detected after adjustment. Following adjustment for age, gender, BMI, smoking, drinking, exercise, energy intake, fat intake, periodontal treatment needs and education or income, the adjusted odds ratios and 95% confidence intervals (CI) of tooth brushing ≥3 per day in the highest income group were 1.264 (95% CI, 1.094-1.460) and 2.686 (95% CI, 2.286-3.155) for highest education level group. The adjusted odds ratios for the use of secondary oral products in the highest income and highest education groups were 1.835 (95% CI, 1.559-2.161) and 5.736 (95% CI, 4.734-6.951), respectively, after adjustment for age, gender, smoking, BMI, exercise, calorie intake, periodontal treatment requirements or income. The present study demonstrated an association between SES and oral health behaviors in a large sample of the Korean population. Within the limits of the present study, income and education were suggested as potential risk indicators for oral health behaviors; therefore, patients with a low SES should be investigated further, in relation to oral health.

Current stress and poor oral health

Background

Psychological stress appears to contribute to poor oral health systemically in combination with other chronic diseases. Few studies directly examine this relationship.

Methods

Data from a cross-sectional study of 2,412 participants between the ages of 25–64 years old living in the City of Toronto between 2009 and 2012 were used to examine the relationship between current stress and two self-rated oral health outcomes (general oral health and oral pain). Dental care utilization and access to dental insurance were examined as effect modifiers.

Results

A positive relationship between current stress and poor oral health was observed for both outcomes (oral pain coefficient 0.32, 95 % CI 0.26–0.38; general oral health coefficient 0.28, 95 % CI 0.19–0.36). Effects on oral pain were stronger for the uninsured, while effects on general oral health were stronger with decreasing socioeconomic position.

Conclusions

Our findings suggest that individuals with greater perceived stress also report poorer oral health, and that this relationship is modified by dental insurance and socioeconomic position. These findings warrant a greater focus on the role of psychological stress in the development of oral disease, including how perceived stress contributes to health inequities in self-reported oral health status. Patients experiencing stressful lives may differentially require closer monitoring and more vigilant maintenance of their oral health, above and beyond that which is needed to achieve a state of health in the oral environment of less stressed individuals. There may be health promoting effects of addressing psychosocial concerns related to dental care - particularly for the poor and uninsured.

Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation

BACKGROUND AND OBJECTIVES

Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health.

METHODS

Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale.

RESULTS

The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points.

CONCLUSIONS

The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.

Anthropometric measurements and dental caries in children: a systematic review of longitudinal studies

There is growing interest in the association between anthropometric measurements and dental caries in childhood over time (life-course studies). The aim of this review was to identify and systematically review the evidence of the association between anthropometric measurements and dental caries in childhood over time. PubMed, Institute for Scientific Information (ISI) Web of Knowledge, the Cochrane Library, and 6 other databases were searched to identify effective articles. A systematic approach involving critical appraisal was conducted to examine the relation between anthropometric measurements and dental caries in preschool- and school-aged populations from longitudinal studies. An initial search identified 1338 studies, with 59 potentially effective studies (κ = 0.82) and 17 effective studies (κ = 0.88). The quality of reporting among the studies ranged from 19.5 to 30.0 according to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) criteria. Among the effective studies, 2 studies in which caries was used to predict anthropometric measurements consistently found an inverse association and 15 studies in which anthropometric measurements were used to predict caries were inconsistent, with results appearing to be influenced by nonuniformity of assessments, setting, and procedure of measurements; age and ethnicity of participants; and confounders of dental caries. In conclusion, among >1000 studies identified, 17 informed this systematic review. The quality of reporting of these studies varied considerably. Evidence of the association between anthropometric measurements and dental caries is conflicting and remains inconclusive.

A microbiological assessment of the oral hygiene of 24-72-month-old kindergarten children and disinfection of their toothbrushes

BACKGROUND

The objective of this study is to assess the index of decayed, missing and filled teeth (DMF-T), habit of brushing teeth, and the microbiological agents accumulating on the children's toothbrushes for 4 weeks and response of these agents to disinfection via a chlorhexidine solution, then compare those results with the education and income levels of the children's parents.

METHOD

Included in the study were 187 children (96 in the control group and 91 in the experiment group - chlorhexidine) chosen randomly from 600 kindergarten children whose ages ranged from 24 months to 72 months. The children selected had not taken any antibiotics, antimicotics for three months and dental treatments during this trial. The distribution of these children to the groups was also done randomly. After performing a survey for the education, occupation, and income status of the parents, the children were examined and the number of decayed teeth was recorded. The children were given toothbrushes, toothpaste (with fluroide), and the solutions (including distilled water and chlorhexidine) for four weeks under the condition that toothbrushes were returned at the end of each week. The 14 different microbiological agents observed as a result of the assessment of the samples taken in the first week were also included in the assessments of the samples taken over the four-week period.

RESULTS

The decrease in the DMF-T index was found to be meaningful according to the differences in education, income, and occupation status of the parents. Of all the samples taken from the toothbrushes, the bacteria with the greatest rate of reproduction included Streptococcus mutans, Escherichia Coli, Pseudomonas aeuroginosa, Enterococcus spp, Staphylococcus epidermidis and Candida albicans. Except for Candida albicans, the other microorganisms taken as samples from the toothbrushes reproduced less overall. In the group using the solution with chlorhexidine, a meaningful decrease in bacterial reproduction was discovered compared to the control group.

CONCLUSION

The findings of this study show that the education, occupation, and socioeconomic situations of the parents should be considered when discussing children's oral and dental health. Moreover, the study shows that disinfection of toothbrushes in order to prevent reinfection and contamination oral flora with the bacteria again is important in terms of preventive medicine and family-children health.

The ethical imperative of addressing oral health disparities: a unifying framework

Health disparities are preventable differences in the burden of disease or opportunities to achieve optimal health that are experienced by socially disadvantaged population groups. Reducing health disparities has been identified as an ethical imperative by the World Health Organization's Commission on Social Determinants of Health and numerous other national and international bodies. Significant progress has been made over the past years in identifying vulnerable groups, and 'distal' factors including political, economic, social, and community characteristics are now considered pivotal. It is thus unsurprising that the remarkable advances in the science and practice of dentistry have not led to notable reductions in oral health disparities. In this review, we summarize recent work and emphasize the need for a solid theoretical framing to guide oral health disparities research. We provide a theoretical framework outlining pathways that operate across the continuum of oral health determinants during the lifecourse and highlight potential areas for intervention. Because oral health disparities emanate from the unequal distribution of social, political, economic, and environmental resources, tangible progress is likely to be realized only by a global movement and concerted efforts by all stakeholders, including policymakers, the civil society, and academic, professional, and scientific bodies.